| VAERS ID: |
961705 (history) |
| Form: |
Version 2.0 |
| Age: |
60.0 |
| Sex: |
Male |
| Location: |
Ohio |
| Vaccinated: | 2021-01-18 |
| Onset: | 2021-01-20 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
E51686 / 2 |
LA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-20
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phenergan, melatonin, clonazepam, vit d, asorbic acid, zinc, cholecalciferol, lomotrigine, cimetadine, quetiapine,
Current Illness: none
Preexisting Conditions: Frontotemporal dementia, copd, type 2 diabetes with kidney disease, Anxiety, Atherosclerotic heart disease, covid 19 on 10/15/2020
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:
Write-up: approximately 3 hours prior to expiring the patient was experiencing forceful emesis. later was found to have expired, patient was comfort care only. |
